[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-194453-105":53,"doc-detail-194453-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","school-health-entry-exam-form-dh3040-chapter-07-2013","School Health Entry Exam Form Dh3040 - Chapter 07 - 2013","","This document is a Health Entry Exam Form for school admissions, specifically designated as form DH3040, Chapter 07, from the year 2013. It is designed to collect essential health information about a child for school enrollment purposes. The form includes sections for the child's basic information such as name, birth date, sex, address, and the school they attend. It also requires details about the parent or guardian, including their name and home telephone number. A significant portion of the form is dedicated to recording the results of comprehensive medical examinations. This includes a Vision Examination for children aged 3-5, a Dental Examination, and a Hearing Screening. For each examination, the form prompts for the date of the exam, the results, and the name of the healthcare provider. Crucially, it also provides space to describe any corrective actions taken for detected problems and any necessary accommodations. The form concludes with a section to record vision and hearing test results, and requires the signature and date of the health care provider, along with their address. This form serves as a critical document for ensuring that children meet the health requirements for school entry and that any health concerns are properly documented and addressed.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/school-health-entry-exam-form-dh3040-chapter-07-2013/194453/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/school-health-entry-exam-form-dh3040-chapter-07-2013/194453.png","ImageObject",442,249,{"name":88,"@type":89},"Violet","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-07","2026-09-03",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of the School Health Entry Exam Form DH3040?","Question",{"text":109,"@type":110},"The form is used to collect essential health information about a child for school admission, documenting their health status and any necessary medical interventions or accommodations.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What specific medical examinations are required by this form?",{"text":114,"@type":110},"The form requires details on a Comprehensive Vision Examination (for ages 3-5), a Comprehensive Dental Examination, and a Hearing Screening.",{"name":116,"@type":107,"acceptedAnswer":117},"What information needs to be provided for each medical examination?",{"text":118,"@type":110},"For each exam, the form asks for the date of the exam, the results, the name of the healthcare provider, and a description of any corrective actions or accommodations needed.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},194453,1790084214,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},4398048950312,"https://ap-avatar.wpscdn.com/avatar/400002538284de19e3c?_k=1778320343897328908","| Name of Child (Last, First, Middle) |  | Birth Date | Sex |\n| --- | --- | --- | --- |\n| Address (Street) |  | School | Grade |\n| City and ZIP Code | Home Telephone Number | Parent/Guardian (Last, First, Middle) |  |\n\n\n|  |\n| --- |\n|  |\n|  |\n\n\n| 1. Comprehensive Vision Examination (3-5 years of age) Date of Exam:  \u003Cbr> Results of Exam:  Health Care Provider:  \u003Cbr>(check one) Optometrist  Ophthalmologist  | Please describe any corrective action for any problems detected and any accommodations required. |\n| --- | --- |\n| 2. Comprehensive Dental Examination\u003Cbr>Date of Exam:  \u003Cbr> Results of Exam:  Dentist:   | Please describe any corrective action for any problems detected and any accommodations required. |\n| 3. Hearing Screening\u003Cbr>Date of Exam:  \u003Cbr> Results of Exam:  Health Care Provider:   | Please describe any corrective action for any problems detected and any accommodations required. |\n\n| Name of Child (Last, First, Middle) | Birth Date |\n| --- | --- |\n\n\n| Vision-Without Glasses | Right 20/  | Left 20/  | Passed Failed Referred | | Hearing – Right | Passed  Failed  Referred  |\n| --- | --- | --- | --- | --- | --- | --- |\n| Vision-With Glasses | Right 20/  | Left 20/  |  |  | Hearing – Left | Passed  Failed  Referred  |\n\n|  |\n| --- |\n|  |\n|  |\n|  |\n|  |\n\n\n|  |\n| --- |\n|  |\n|  |\n|  |\n|  |\n\n| Signature/Title of Health Care Provider | Date | Address (Please print or stamp) |\n| --- | --- | --- |\n| ⌦ |  / /  |  |\n| Name (Please print or stamp) |  |  |\n|  |  |  |","cbCaib1391WqHJ7J","https://ap.wps.com/l/cbCaib1391WqHJ7J","pdf",64150,"English","# Child Information\n# Medical Examinations\n## Comprehensive Vision Examination\n## Comprehensive Dental Examination\n## Hearing Screening\n# Vision and Hearing Test Results\n# Health Care Provider Information","[{\"question\":\"What is the purpose of the School Health Entry Exam Form DH3040?\",\"answer\":\"The form is used to collect essential health information about a child for school admission, documenting their health status and any necessary medical interventions or accommodations.\"},{\"question\":\"What specific medical examinations are required by this form?\",\"answer\":\"The form requires details on a Comprehensive Vision Examination (for ages 3-5), a Comprehensive Dental Examination, and a Hearing Screening.\"},{\"question\":\"What information needs to be provided for each medical examination?\",\"answer\":\"For each exam, the form asks for the date of the exam, the results, the name of the healthcare provider, and a description of any corrective actions or accommodations needed.\"}]","School Health Entry Exam Form Dh3040 - Chapter 07 - 2013 | PDF",1788439233]